Panic Disorder can be described as a "fear of fear". According to the DSM-IV classification, a central feature of panic disorder is a history of panic attacks accompanied by a persistent fear of having another one as well as concern about what the panic attacks mean or what they might lead to. If you have had a panic attack or two, this does not mean that you have panic disorder. Panic attacks are not uncommon, and may also be part of other anxiety disorders. It is the persistent concern about having another panic attack, and the fear of certain bodily sensations associated with anxiety and panic that distinguishes panic disorder.
When people avoid places or situations for fear of having a panic attack in that setting, they are said to have Panic Disorder with Agoraphobia. The Greek word agoraphobia literally means "fear of the marketplace", and in fact people with agoraphobia often avoid malls and supermarkets, as well as driving on freeways and over bridges, flying, or sitting in the center row of a crowded theater. In other words, situations from which it would be difficult to exit, escape, or excuse themselves in the event of acute anxiety or panic.
Researchers estimate that as many as 6 percent of people suffer from Panic Disorder at some point in their lives. According to the DSM-IV, the criteria for Panic Disorder includes the following:
- The experience of recurrent unexpected panic attacks
- Persistent concern about having another panic attack, the implications of the attack or its consequences, or a significant change in behavior related to the attacks.
- The panic attacks are not better explained by another anxiety disorder, a medical condition (like hyperthyroidism, heart palpitations, or hypoglycemia) or the use of substances.
Panic attacks are acute episodes of intense dread or fear that are accompanied by a number of physical sensations that can include:
- pounding heart
- feelings of choking
- chest pain
- dizziness or lightheadedness
- numbness or tingling
- hot flashes, sweating
- feeling unreal or detached from oneself
All of these sensations are caused by the fight-or-flight response, and are accompanied by a strong urge to escape or flee. In fact, a panic attack is like an "escape program" that is triggered in your brain. For people with panic disorder, there is a tendency to interpret these sensations in a catastrophic way. For example, they may have the thought that they are dying, or that they are going to lose control or "go crazy". Unfortunately, the body responds to these alarming thoughts by increasing the fight-or-flight response, resulting in increased physical sensations, and more alarming interpretations, leading to a "vicious cycle" of escalating panic.
In panic disorder, more than in any other of the anxiety disorders, the control paradox is a critical factor. Since the fight-or-flight response is what our body uses to control or change a situation, all efforts to control or get rid of the uncomfortable sensations lead to increased fight-or-flight arousal, which means more uncomfortable sensations. For this reason, the focus on acceptance of anxiety that is central to acceptance and commitment therapy (ACT) has proven to be extremely helpful for people suffering from panic disorder. The essential components of ACT are presented in The Worry Trap.